What Health Care Reform Has and Has Not Accomplished One Year Later

Just a month ago, a new poll revealed that 22% of the public thought health reform had been repealed, and another 26% were unsure or unwilling to say. Apparently there are some misunderstandings in need of being cleared up.
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Six months ago, I wrote a blog on what health reform had accomplished halfway through the first year of implementation. This week, March 23, 2011, it will be one year since President Obama signed health reform into law, but few Americans can tell you what has been accomplished in the last year.

Just a month ago, a Kaiser Family Foundation poll revealed that 22% of the public thought health reform had been repealed, and another 26% were unsure or unwilling to say. The poll results noted:

"Nearly one in three Republicans thought the law had been repealed. One in four independents and one in eight Democrats thought the same. People with higher incomes as well as those with college degrees were more likely to have an accurate view of the status of the law."

The polling on health reform has shown only a few percentage points separating voters for or against health reform over the past year. Yet, while a slight majority of the public currently disapproves of the health reform law, 55% also disapprove of defunding the law.

So what's going on? Most likely, the ambivalence about reform is the result of both too much information and not enough -- of the factual kind, that is. If almost half of the public doesn't even know that the law is still the law, that means that most have not noticed or felt the impact of the changes that have already been implemented. And truly, if you have not been sick or used your insurance (if you have it), you wouldn't really know much about what is happening in this area. It may also mean that people have believed the scary emails they receive or the constant barrage of criticism of health reform.

This week you will hear a lot about the benefits of health reform. Indeed, there have been some changes that most of the public supports -- things like a ban on pre-existing conditions for kids; preventive care without a co-pay; restrictions on annual benefit limits and no lifetime limits on care; assistance to small business in the form of tax credits for providing insurance to their employees; assistance to employers to continue benefits for retirees under 65. There are many websites that can explain what health reform has accomplished, and many people will be highlighting these benefits during the coming week.( If you want to check out the benefits, you can find information at the White House site and the Families USA site. )

The purpose of this blog is not to convince you that health reform is the best thing ever, though. I just thought it might be helpful to answer a few basic questions you may hear about reform so that you can be helpful to family and friends and just a little more knowledgeable. If you have your own questions, please submit them in your comments and I will do my best to answer them or find someone who can.

Some Basic Questions About Health Reform:

Q: Has the health reform law been repealed?

A: No. The Affordable Care Act (ACA) is still the law of the land. There is one aspect of the law that is on the way to being repealed, and that is a reporting requirement for small business that everyone, including the President, agreed was not the best way to raise revenue.

Q: Can the Congress repeal the ACA?
A: Probably not. At least not while the Senate is held by the Democrats and we have a Democratic President. It is possible that if the Republicans were to win the Senate and the Presidency in 2012, the whole law could be up for repeal, but since there have been quite a few good things already implemented, most experts feel that it would be difficult to undo the whole law.

Q: What good has health reform done for me?
A: The answer to that depends on who you are and what your health situation is. The White House website on health reform has a whole menu of ways that health reform might have benefited you. Check it out.

Q: What about all the rumors I hear about health reform causing death panels, higher taxes, rationing, and putting the government between me and my doctor?
A: I spend a fair amount of time helping friends track down rumors about health care. The best source I know is "Politifact" -- http://www.politifact.com/subjects/health-care/ -- There are 23 pages of health reform rumors on this site, all which have been analyzed and rated as to whether or not they are true. Politifact puts the emails that are circulating with these rumors to the test of facts and helps you figure out whether the rumor is false, barely true, mostly true or true. It's best not to circulate that email to your friends until you check it out with Politifact or Factcheck.org. These are reputable sites that are really "fair and balanced".

Q: Why are my insurance premiums going up? I thought health reform would bring them down?
A: First of all, health reform has not been fully implemented and will not be until 2014. In some cases where insurance premiums have gone up substantially it is because insurance companies may be trying to build up their reserves while they wait for the full health reform act to be implemented, and one way to do that is by increasing premiums. The individual market is volatile, however, so there is some credence to the argument that these increases reflect real increases in utilization and cost. Health care costs have been going up every year before reform passed, so the only reason I can think of for decreased costs this year would be for an insurance company to try to capture more market share in anticipation of the 2014 implementation date.

Both Anthem Blue Cross in California and Blue Shield of California proposed increases in individual plan premiums of over 30% for next year, but they were forced to back down. They claimed that those increases were all supported by actual increases in the use of medical care by their members, but the State Insurance Commissioner in California investigated the claims and found errors in the submitted data. About 20 states (not California) have laws that allow their insurance departments to "require" insurance companies to submit increases for review and approval.

Q: How will health reform control costs once the state "exchanges" or health insurance marketplaces are up and running?
A: Most analysts believe that once you promote real competition among plans in the "exchange", costs will moderate as consumers become more able to choose among their options and plans have to actually compete for business. Republicans advocate the sale of health insurance across state lines to promote competition, but the problem with that solution is that insurance companies would seek to incorporate in a state with no or little regulation, so the market could be flooded with so-called "low cost" plans that cover less than a hospital gown. There are also provisions in the law that would allow Medicare to experiment with new ways of paying providers that could encourage better care at lower costs to the patient.

Q: Will I be able to keep my doctor after health reform is implemented?

A:Yes. Nothing specific in health reform should cause you to change your doctor or health plan. However, some doctors may retire early or limit the number of health plans they accept. It's more likely that doctors will continue to contract with the same plans they do now.

Q: Will there be enough doctors to treat all the newly insured patients once reform is implemented in 2014?
A: Probably not, certainly in some areas. This is a big concern of policymakers. Clearly the use of nurse practitioners will be critical, and there is funding in the legislation for increased training of primary care practitioners. Nevertheless, there will be shortages and that will undoubtedly be frustrating for patients as well as providers.

Q: Why is it taking so long to implement health reform?
A: When the law was written, it was anticipated that establishing the state exchanges and the rules for operating them would be very complex and it would take time to implement all of it. The law includes many more features than the exchanges, however. It includes thousands of different changes in the way quality health care can be delivered, including new rules for the insurance part, incentives for better data collection, new research comparing treatments to find out what works best, money for training providers, etc. The dilemma in rolling out reform was to figure out how to provide some instant "wins" in the first year, while the rest of the program was developed at the state level. Each state will have a slightly different version of an insurance marketplace, and that will take time to develop as well.

Here's my question for all of you: can you name five benefits of health reform in its first year? After this week, hopefully you can.

P.S. Check out this great flow chart from the Kaiser Family Foundation -- shows you how health reform exchanges will work and where you might fit in.
http://healthreform.kff.org/the-basics/access-to-coverage-flowchart.aspx?wpisrc=nl_wonk

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